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Home My WebLink AboutBuilding Permit #452-2017 - 21 SPRUCE STREET 10/28/2016 w �1ORT, 4b)I )VOL,r'✓ BUILDING PERMIT DE �,Vlo ,6 9� 7 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION � Z y Permit No#: qS-1 ;;Lo 1 7 Date Received G US � Date Issued: / IMPORTANT:Applicant must complete all items on this page LOCATION 2.1 SOrlAot- SkcfAk Print PROPERTY OWNER 1'gI* At, Print 100 Year Structure yes Cno MAP O33 PARCEL: 00 �- ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial p(Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other �;Septic ❑wlall p FLoodpLairi INetlantls 1lllafersh_,District, Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: A.i r seam na dam vrzi n a • insuA a a 6h C 1, bacK of alh'. access ba sevruti,- Identification- Please Type or Print Clearly OWNER: Name: Enc 1-tator Phone: ("9)6w- 45-T2 Address: 21 S ru(A- Nu o M 6 T4 Contractor Name: Wc3gW JoM Phone: (SD$) 38'2- 208'7 Email: ln6orytWCA m Address: 'kb &10,&H,c3k e . NN oatog Supervisor's Construction License: 110041 Exp. Date: 7 2pict Home Improvement License: Exp. Date: -712-1/ Z01 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 2 Slo 1. 2(. FEE: $ O Check No.: 2- 13 Receipt No.: 3 NOTE: Persons contracting with unregistered contractors do not have access to the guarantufund _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFVICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS k . HEALTH Reviewed on' Signature COMMENTS Zoning Board of Appeals:_Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: ' Comments Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: - Located 384 Osgood Street FIRE;DEPP 4R�TMENT T,`emptDumpster orrsife Locatedlat 124IMainxStfeet Fire Depart-r iit•signature/date;__ COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe:Building Permit Revised 2014 Location r U C t= No. 4�i .a 01-7 � Date of � . - TOWN OF NORTH ANDOVER y Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# c� r Building Inspector NORT01 t Town of :. sAndover i NO. ; � � i _ _ _ h h ver, Ma o K ss, O/ A_ COCHICHN WICM ��• 7d ADRATED S U BOARD OF HEALTH Food/Kitchen PERMIT. LD Septic System THIS CERTIFIES THAT ......... I.I.G. y............................. BUILDING INSPECTOR . has permission to erect .......................... buildings on ...........��...I.......�&vcm-.te.,...,,,.�'.�. ,j. ...... Foundation Rough to be occupied as .........W 1*r.1P......541.04 01.../nfiorm�. .�.�.� .�............... Chimney provided that the person accepting this permit shall in every respect c to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTf Rough Service .....•.,..•....... ............ .... .. .. .. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. P RISE60 Shawmut Road, Unit 2, Canton,MA 02021 f339-502-6335 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM (Owner' ame) ' owner of the property located at 1 `' rY ' C-- ''_ . .i . (Property Address) ' (Property Address) hereby authorize WW U�l Eywx m (Subcontractor)I V I ' an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. e-p-� S l carr--- Own6r's Signature Date Federal 10 0 0644066621) RISE Engineering FU Contractor Registration No 8186 MA Contractor Registradon No 120979 A division oribicisch Engineering RISE60 Shaw-mut Road,Canton,MA 82021 ENGINEERING' 339-502-6335 —FAX339-502-6345 CONTRACT - Page 1 PROGRAM CNIA-HES z==q=rZMww" PH= DAM MEMO VIM ORDER Eric TullsEren i (978)688 6592 0810812016 438411 00002 satVICA 21 Spruce Street 21 Spruce Street ommes 0w.sVk1P42P sum C1111F.Saxap North Andover.MA OW5.. 1 North Andover.MA 01845 JOB DESCRIPTION HEALTH&SAFETY: Have your heating system tuned up and retested to be sure that the undiluted Rue gasses do not exceed 100 parts per million(ppm)carbon monoxide.Weatherization work cannot proceed until this is fixed. $0.00 BARRI ER-.We have discovered what appears to be a mold/mildew-lik-e substance in your home.This is being brought to your attention to identify it as a pre-existing condition to the insulation and air sealing cork planned for your home.Your signature is your acknowledgement uftbese conditions and agreement to proceed.SEE PICTURES $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against mastefid.excess air leakage. This work will bc performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks.foams and other products. Primary areas for scaling inch*air leakage to attics,basements,attached gamps and other unheated areas(windows are not generally addressed) This will require(9)working hours A reduction in cubic fen per minute(cftn)of air infiltration wall occur.but the actual number ofcfm is not guaranteed. At the completion of the watherizai ion wrk,and at no additional cost to the homeowner.a final blower door and/or combustion safety analysis will be conducted by the stib-contractor to ensure the safety of the indoor air quality. $680.00 MILDEW IN BASEMENT ON FOUNDATION WALLS.JOISTS IN ATTIC ON RAFTERS AND GABLE END.SEE PICTURES $0.00 DAMMING:Provide labor and materials to install a 12"layer or R-38 unlaced fiberglass balls to(71)wpm feet for damming purposes. $145.55 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Chiss I Cellulose added to(784)square feet of open attic space. $987.84 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items Mocking the installation ofmcatherization work in the attic. Removal must occur prior to the scheduled work start.<<initial— $0.00 ATTIC ACCESS:Provide labor and materials to install(1)easily removed Thermal Tent cover for the attic access folding stair. The cover has integral weatherstripping to restrict air leakage.Width:72"or 2S"(circle one). $226.65 VENTI LATION:Provide labor and materials to install ventilation chutes in(64)rafter bays to maintain air flow. $128.00 BASEMENT CEILING Provide labor and materials to install(132)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $231.00 J • j. Federal ID 6 064405629 / RISE Engineering RI Contractor Registration No 8186 tAAContractor Registratlon No 120979 Adltisioa ofihielsch Engineering Ri S 60 Sbawmat Road,Canton,?JL4 02021 ENGINEERING CONTRACT 339-502-6335 FA.\339-5t12-6315 Page 2 PROGRAM 1M C MarAM ta+ee M ttao6EINEERROE CMAFEES 003CYOWEESUMEWMANOVECOMMraewaaas eusloMER atrortE "M aims WautoetDeR Eric Tullgren (978)688.6582 08/08/2016 438411 00002 SERVICE GUEST saim SIRW 21 Spruce Street 21 Spruce Street 89RVIC E CW.STUL W SMUNG OW.61►R.2tP North Andover,MA 01845 North Andover;MA 01845 JOB DESCRIPTION BASEMENT DOOR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and seams with FSK tape. $72.22 INCENTIVE:RISE Engineering utll apply all applicable,eligible incentives to this contract. You cwll only be billed the Net amount. Currently.for eligible measures.Columbia Gas offers an incentiveof 7346,not to exceed$2,000 per calendar year.and an incentive of 100%for the Air Sealing measures up to$1.020 FOR A LIMITED TIME:Columbia Gas will also offer an additional$100 incentive touards the cicatherization cork outlined in this proposal.This special Summer incentive is available to homeowtters Who have had their Columbia Gas home energy audit before Augm 31,2016. A signed proposal for wcatherizat ion needs to be s ibmitted by September 9,2016 and work must be completed by September 30,2016. For the safety and health of yotr home's indoor air quality.ue will be conducting a Maus door diagnostic of the available air flow in your home both before the cork is begun,and after the ueatherization cwrk is complete.We cell also conduct a full assessment of the combustion safety of your heating system and aster heater.This has a value of$90 and is at no cost to you The maximum allowable incentive for all measures,including air sealing is$3110 T he Permit will be secured by the insulation contractor.at no additional cost.It is the homeocmces responsibility to close out this permit by contacting their municipality at the completion of this aork. $90.00 Total: $2,561.26 Program Incentive: $2,21345 Customer Total: $347.81 WEAGMHEREBYTOPURKISNS9tVICES-CCIMETEatACCORDAWAWITHAMMSP AT10119.FORTHEtartyOF ***Three Hundred Forty-seven 8 811100 Dollars $347.81 IA=A"V�AtAtOficsaM UA SanMIMPon 6aARAMUSS �R�1dN. t% A O�COMCWO YIM DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES "I-/' . or--A— 6--W-Ii-'; StO[fA Enplgtar5 GU$=K'R Z / tom.7effi Y aE WIWdtARA/HY Ua O<rtDrEiOCVED WnIRN DAR OPACtEPODOE J A • CF00111RACT-1eEINS AND CO NIM ARE AS = SQGAracRD� iDDolawr W ASe VMWfWMLBEMDfi� E The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 4.2114-2417 www.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE I'1;PMTTING AUTHORiTV. Applicant Information Please Print Legibly Business/Organization Name:Mill City Energy Address:PO Box 6411 City/State/Zip:Manchester, NH 03108 Phone#:603-391-7923 Are you an employer?Check the appropriate box: Business Type(required): 1.21 I am a employer with 12 employees(full and/ 5. Retail or part-time).* 6. Restaurant/Bar/Eating Establishment 2.E3 I am a sole proprietor or partnership and have no 7• ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. (No workers'comp.insurance required] 3• Non-profit 3.[] We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. .152,§1(4),and we have 10•Q Manufacturing no employees.[No workers'comp.insurance required]* 4_❑ We are a non-profit organization,staffed by volunteers, I I.❑Health Care with no employees.[No workers'comp.insurance req.] 12.14 Other VJIWIUylgahoy� *Any applicant that checks hoz#1 must also nil1 out the section below showing their+Avrkers'compensation policy information. "If the corporate officers have exempted themselves,but the corporation has other employees;a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. ,Below is the policy information. Insurance Company Natne:Clark Insurance Insurer's Address:One Sundial Avenue Suite 302N City/State/Zip: Manchester, NH 03102 Policy#or Self-ins.Li,.#MIWC791896 Expiration Date:4/29/2017 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment as well as civil penalties in the forna of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify,uins acrd penalfies of perjury that the information provider(above is true and correct. Simature: Date: 0-1-21 ZV L L Phone#:603-396-7520 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www_mass.gov/dia MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 7//19/219/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#AGR8150 CONTACT Clark Insurance PHONE FAX One Sundial Ave Suite 302N ac No Ext:(603)622-2855 ac No):(603)622-2854 Manchester,NH 03102 AIL ADDRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER B:AInGuard Ins co 43290 Mill City Energy INSURER C: 106 Joseph St _INSURERD: PO Box 6411 Manchester,NH 03102 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR TYPE OF INSURANCE D D POLICY NUMBER ADDLSUBR MIOM/LDID EFF POLIO(MMIODEXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR 8500065735 04/29/2016 04/29/2017 _"AME 300,000 OR N PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO 1020050919 04/2912016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accdent $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ _ 1,000,00 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE MIWC791896 04129/2016 04129/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? Fij] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addttlonal Remarks Schedule,may be attached H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of public Safety Construction Supervisor } Board of Building Regulations and Standards Restricted to: Unrestricted-Buildings of any use group which contain License:CS-110041 less than 35,000 cubic feet(991 cubic meters)of Construction Supervisor enclosed space, MICHAEL JOY 106 JOSEPH STREET :r MANCHESTER NH 03102 Failure to possess a current edition of the Massachusetts ^n CA— Expiration: State Buildirg Code is cause for revocation of this license. Commissioner 08/07/2019 DPS Licensing Information visit:WWW.MASS.GOv/DPS "'yhr Cr,rr.nr.m.*,.lfA r "`7leaGr'f•eSfxC f- ( t or registration,,-alid for individul use on ! t)ffirr aTCoasomrrAtfmrs&A ess RtgnlaFlda ° p----� OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ^.,[.. . s ation; 162782 fltrxe of Consumer Affairs and Business Regulation Tyle 1 eglstr acpiraitt►n; 7T27C2017 LLC 10 Pt+rk Pizza-Suite 5170 { r � Boston,AiA 02116 MIL. ENERGY.LLC, MICHAEL JOY 106 JOSEPH STREET' ..] MANCHESTER,NH 03102 �'— t s - t'ndervrrrtary E� ra __ ithouts tire